Chung Jaehoon, Kim Hack-Lyoung, Joh Hyun Sung, Lim Woo-Hyun, Seo Jae-Bin, Kim Sang-Hyun, Zo Joo-Hee, Kim Myung-A
Division of Cardiology, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang-si, Gyeonggi-do, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Hum Hypertens. 2025 Jul 9. doi: 10.1038/s41371-025-01044-2.
The effectiveness of diagnostic tools can be enhanced by their combination. This study aimed to investigate whether total arterial stiffness data, obtained by brachial-ankle pulse wave velocity (baPWV) measurement, could improve prognostic value to exercise treadmill test (ETT) to predict future cardiovascular events. A total of 1 610 consecutive subjects (mean age 56.3 ± 9.8 years, 59.4% men) with suspected of having coronary artery disease (CAD), who underwent ETT and baPWV on the same day were prospectively recruited. The study outcome was major adverse cardiovascular event (MACE), a composite of cardiac death, non-fatal myocardial infarction, and coronary revascularization. During a mean follow-up period of 938 days (interquartile range, 125-2 252 days), there were 61 cases of MACE (3.8%). The elevated baPWV (≥1 526 cm/s) (hazard ratio [HR] 2.99, 95% confidence interval [CI] 1.64-5.46, P < 0.001) and positive ETT result (HR 4.18, 95% CI 2.48-7.06, P < 0.001) were associated with MACE even after adjustment for potential confounders. The combination of baPWV to traditional risk factors and ETT result further stratified the subjects' risk (low baPWV and negative ETT result vs high baPWV and positive ETT result; HR 14.11, 95% CI 5.74-34.69, P < 0.001). Total arterial stiffness, assessed by baPWV, had incremental prognostic value to ETT result in patients with suspected of CAD. Combined information of baPWV and ETT result can serve as a useful clinical tool for risk stratification in this high-risk patient population.
诊断工具联合使用可提高其有效性。本研究旨在探讨通过测量肱踝脉搏波速度（baPWV）获得的总动脉僵硬度数据能否提高运动平板试验（ETT）预测未来心血管事件的预后价值。前瞻性招募了1610例连续的疑似冠心病（CAD）患者（平均年龄56.3±9.8岁，男性占59.4%），这些患者在同一天接受了ETT和baPWV检查。研究结局为主要不良心血管事件（MACE），包括心源性死亡、非致死性心肌梗死和冠状动脉血运重建。在平均938天的随访期内（四分位间距为125 - 2252天），发生61例MACE（3.8%）。即使在对潜在混杂因素进行调整后，baPWV升高（≥1526 cm/s）（风险比[HR] 2.99，95%置信区间[CI] 1.64 - 5.46，P < 0.001）和ETT结果为阳性（HR 4.18，95% CI 2.48 - 7.06，P < 0.001）仍与MACE相关。baPWV与传统危险因素及ETT结果相结合进一步对受试者风险进行了分层（低baPWV和ETT结果为阴性 vs 高baPWV和ETT结果为阳性；HR 14.11，95% CI 5.74 - 34.69，P < 0.001）。通过baPWV评估的总动脉僵硬度对疑似CAD患者的ETT结果具有增量预后价值。baPWV和ETT结果的联合信息可作为这一高危患者群体进行风险分层的有用临床工具。
